Abstract
This Note examines how current regulatory policies and practices of Pharmacy Benefit Managers (PBMs) have led to increased prescription drug costs and diminished patient access to medications. Notably, Schmidtknecht v. OptumRx Inc. illustrates the real-world consequences of current PBM regulation, which allows them to increase medication prices without warning by controlling which pharmacies and insurance plans will cover certain prescription drugs. The Note analyzes existing federal regulations under the Civil Monetary Penalties Law (CMPL), the Patient Right to Know Drug Prices Act (2018), and the Know the Lowest Price Act of 2018, which seek to increase drug pricing transparency and consumer access to medication pricing information. It further evaluates proposed reforms, including the Pharmacy Benefit Manager Reform Act (2023), the Pharmacy Benefit Manager Transparency Act (2023), the Protecting Patients Against PBM Abuses Act (2023), and the Lower Costs, More Transparency Act (2023 House bill), which mandate greater disclosure of reimbursement practices. The Note also analyzes the Illinois Insurance Code § 215 ILCS 5/513b1 as a model for PBM oversight and pharmacy reimbursement protections. Finally, the Note argues that meaningful reform on federal and state levels is needed to enforce pricing transparency, eliminate structural conflicts of interest, and restore competitive equilibrium within the pharmaceutical supply chain.
Recommended Citation
Riley Harris,
Held Hostage by High Prices: How the Pharmacy System Makes You Pay More,
50
S. Ill. U. L.J.
440
(2026).
Available at:
https://opensiuc.lib.siu.edu/siulj/vol50/iss2/10